Earliest manifestation of megaloblastic anemia is
Correct Answer: Hypersegmented neutrophils
Description: (Ref: Harrison 18/e p866, 17/e p645-646, Tejinder Singh 2/e p54-61)
Peripheral blood picture
Bone marrow picture
Macrocytosis (↑ MCV, MCH. Normal MCHC)
Peripheral smear
Macroovalocytes
Few nucleated RBCs
Evidence of dyserythropoiesis like-
Basophilic stippling
Cabot ring
Howell- Jolly bodies
↓ Hb
↓ Hematocrit
Reticulocyte count – Normal or mild decrease
White cells- Leucopenia
Hypersegmented neutrophils/ Macropolycytes- First manifestation
↓ Platelets
Pancytopenia (10-20%)
Lab investigations:
Serum iron, ferritin - ↑ in pure VitB12/ Folate defect
Serum bilirubin & LDH ↑- due to hemolytic component
Schillings test: Used to assess status of intrinsic factor (IF) & Vit B12 to distinguish pernicious anemia from other causes of Vit.B12 deficiency.
Moderate- marked hypercellularity
Erythroid hyperplasia
M:E ratio reversal
Erthropoiesis- Megaloblastic
Giant metamyelocytes
Mildly reduced megakaryocytes
BM iron moderately increased in pure Vit B12/ Folate defects.
Category:
Unknown
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